Provider Demographics
NPI:1487033288
Name:HERBERT & KONG LLC
Entity Type:Organization
Organization Name:HERBERT & KONG LLC
Other - Org Name:BODY-BRAIN RESILIENCE CENTER...
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:857-366-9399
Mailing Address - Street 1:777 CONCORD AVE,
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1053
Mailing Address - Country:US
Mailing Address - Phone:857-366-9399
Mailing Address - Fax:857-263-5810
Practice Address - Street 1:777 CONCORD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1056
Practice Address - Country:US
Practice Address - Phone:857-366-9399
Practice Address - Fax:857-263-5810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOT APPLICABLE (SAME AS ORG - COMPUTER REQUIRING FILLING IN FIELD)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150498208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty